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目的评价腹会阴联合切除术(APR)和低位前切保肛术(LAR)治疗低位直肠癌的疗效差异。方法收集公开发表的腹会阴联合切除术和低位前切术治疗中低位直肠癌的中文和外文文献,将文献中提取的数据按照其对应的术式分别纳入腹会阴联合切除术组(APR组)和低位前切保肛术组(LAR组),对两组的术后并发症发生率、病死率、5年生存率进行Meta分析。结果筛选出符合纳入标准的研究16项(3568例),其中随机对照研究1项。腹会阴联合切除术组和低位前切保肛术组并发症发生率(OR=1.48,95%CI:0.96～2.29;P>0.05)、病死率(OR=2.08,95%CI:0.88～4.87;P>0.05)的差异无统计学意义;5年生存率(OR=0.67,95%CI:0.57～0.79;P<0.05)的差异有统计学意义,低位前切保肛术组的5年生存率均优于腹会阴联合切除术组。结论低位前切保肛术治疗低位直肠癌能够获得更好的远期疗效。
Objective To evaluate the efficacy of abdominal perineal resection (APR) and low anterior anal sphincter preservation (LAR) in the treatment of low rectal cancer. Methods The published Chinese and foreign literatures on abdominal perineum combined with resection and low anterior resection for middle and low rectal cancer were collected, and the data extracted from the literature were included into the abdominal perineal resection group (APR group) according to the corresponding surgical procedures. And low anterior anal sphincter preservation group (LAR group). The incidence of postoperative complications, case fatality rate and 5-year survival rate of the two groups were analyzed by Meta-analysis. Results Sixteen items (3568 cases) were screened to meet the inclusion criteria, including 1 randomized controlled study. The incidence of complications (OR = 1.48, 95% CI: 0.96-2.29; P> 0.05) and mortality (OR = 2.08, 95% CI: 0.88-4.87) in the abdominal perineal resection group and the anterior low anal suture group ; P> 0.05). There was a significant difference in 5-year survival rate (OR = 0.67,95% CI: 0.57-0.79; P <0.05) Survival rate is better than the abdominal perineal resection group. Conclusion Low anterior anal sphincter preservation for lower rectal cancer can achieve better long-term efficacy.